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H5N1 (and other infectious diseases) update with Dr. Alex Isakov

Applying the Hierarchy of Controls to the current U.S. H5N1 outbreak, bird and swine flus

In this episode of EMS One-Stop, host Rob Lawrence welcomes back infectious disease expert Dr. Alexander P. Isakov, MD, MPH, founding executive director of the Office of Critical Event Preparedness and Response (CEPAR), and professor of emergency medicine at Emory University.

Rob begins by discussing his real-life experience with an H5N1 outbreak in the UK as an ambulance service leader, and Dr. Isakov discusses the current H5N1 emergence in the U.S.

The discussion covers the current U.S. H5N1 outbreak, bird and swine flus, and the spillover from bird to mammal populations. They also address three recent U.S. cases of H5N1 among agricultural workers. They go on to discuss signs and symptoms of H5N1, index of suspicion, the Hierarchy of Controls in infectious diseases, universal and standard precautions, and fit testing respirators. They also cover resources available at NETEC.

Dr. Isakov concludes with a roundup of other global issues, including viral hemorrhagic fever (VHF), Ebola, Marburg and smallpox.

| More: Quick-reference guide: Selecting the appropriate PPE

Top quotes from this episode

“While this virus has been tracked by public health authorities since 1997, what’s really different today that’s putting it in the news is this spillover into mammal populations.” — Dr. Alex Isakov

“The EMS clinicians in the field know how to apply the Hierarchy of Controls, including that PPE ensemble that we’ve described because they’ve gotten a tremendous amount of experience doing it during the COVID-19 pandemic.” — Dr. Alex Isakov

“It’s fairly non-specific for the EMS community. I think where this might be of greatest interest is if you are working in a service area or serving a population of people that are, you know, working on dairy cattle farms and working with your local public health department to understand what the risks are.” — Dr. Alex Isakov

Episode contents

00:45 – Introducing Dr. Alex Isakov

01:28 – H5N1 – Rob’s UK H5N1 origin story

04:30 – Original late 90s/2000s exposure rate

05:45 – The current U.S. H5N1 outbreak

06:15 – Bird flus and swine flus

08:00 – Spillover from bird to mammal populations

08:30 – Three recent U.S. cases amongst agricultural workers

09:45 – Signs and symptoms and index of suspicion

12:50 – If CDC says the risk to the human population is low, then why are we talking about this?

14:30 – Remembering the lessons of COVID

16:30 – The Hierarchy of Controls in infectious diseases

17:00 – Universal and standard precautions, and fit testing respirators

18:00 – Resources available at NETEC

19:00 – Is the EMS community ready to transport patients infected with H5N1?

20:30 – Other global issues to monitor

21:00 – Viral hemorrhagic fever, Ebola, Marburg and smallpox

22:40 – The role of call centers in surveillance monitoring

24:00 – Final thoughts

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ABOUT OUR GUEST

Alexander P. Isakov, MD, MPH, is the founding executive director of CEPAR and a professor of emergency medicine at Emory University. He oversees the development of the CEPAR office, providing oversight and leadership for numerous initiatives aimed at improving the disaster resilience of Emory and the broader community. His professional experience includes service as an officer in the United States Navy, consulting for the CDC, deploying with the National Disaster Medical System, and providing leadership in EMS and disaster preparedness. He is also the director for Emory’s Section of Prehospital and Disaster Medicine, whose faculty and staff provide medical oversight for 911 communications centers, first responders, air and ground ambulance services, and special events in the metropolitan Atlanta area.

Dr. Isakov has been active in programs to improve EMS and community disaster resilience locally, regionally and nationally. He led the Academic-Community Partnership for Sustainable Preparedness and Response Systems project of the Emory Preparedness and Emergency Response Research Center, which explored the relationship between academic institutions and the public health preparedness and emergency management communities. He previously served as a member of the Ad Hoc Committee on Strengthening the Disaster Resilience of Academic Research Communities and the Ad Hoc Committee on the Certification of Personal Protective Technologies for the National Academy of Science, Engineering and Medicine. He is currently the emergency medical services lead for the National Emerging Special Pathogens Training and Education Center. He is a member of the Epidemic Expert Panel of the American College of Emergency Physicians and a subject matter expert for the Assistant Secretary for Preparedness and Response, Technical Resources, Assistance Center and Information Exchange. Dr. Isakov was recently funded and tapped to lead a consortium to implement the latest Regional Disaster Health Response System (RDHRS) by the Department of Health and Human Services’ Office of the Assistant Secretary for Preparedness and Response (ASPR).

He is certified by the American Board of Emergency Medicine in both emergency medicine and emergency medical services. He practices clinically in the emergency department of Emory University Hospital and is also the medical director for Emory EMS, Sandy Springs Fire Department and Air Life Georgia.

Rob Lawrence has been a leader in civilian and military EMS for over a quarter of a century. He is currently the director of strategic implementation for PRO EMS and its educational arm, Prodigy EMS, in Cambridge, Massachusetts, and part-time executive director of the California Ambulance Association.

He previously served as the chief operating officer of the Richmond Ambulance Authority (Virginia), which won both state and national EMS Agency of the Year awards during his 10-year tenure. Additionally, he served as COO for Paramedics Plus in Alameda County, California.

Prior to emigrating to the U.S. in 2008, Rob served as the COO for the East of England Ambulance Service in Suffolk County, England, and as the executive director of operations and service development for the East Anglian Ambulance NHS Trust. Rob is a former Army officer and graduate of the UK’s Royal Military Academy Sandhurst and served worldwide in a 20-year military career encompassing many prehospital and evacuation leadership roles.

Rob is a board member of the Academy of International Mobile Healthcare Integration (AIMHI) as well as chair of the American Ambulance Association’s State Association Forum. He writes and podcasts for EMS1 and is a member of the EMS1 Editorial Advisory Board. Connect with him on Twitter.